Think high testosterone means you’re healthy? Experts say not necessarily

Interest in testosterone has increased dramatically in recent decades. It is common for men to seek treatment for fatigue or depression, believing it is due to testosterone deficiency. But the picture of the hormone is often simplified.

To investigate the complex connections between testosterone levels and health, data from large studies in the USA and Sweden were used. The study focused on muscular health, the body’s internal milieu, and identifying which specific symptoms in men could be more closely linked to testosterone levels.

“The clearest connections are found in sexual problems with sexual desire, erection and sexual performance, as well as in some muscle and joint pain, but even here the connections are surprisingly weak compared to men who have normal testosterone levels,” says Amar Osmancevic, a physician and PhD in community medicine and public health.

Muscle health and inflammation

Muscle health and testosterone are also connected. Higher testosterone levels are linked to higher muscle mass and, above all, to less intramuscular fat. This is especially true in muscles with a high percentage of fat: around the stomach, waist, lower back and hips, and in the chest muscles.

“Muscle health is not just about looking muscular but also about the quality of the muscle. Maintaining hormone levels can help the muscles from decreasing in size or remaining stored in fat, which is crucial for metabolism and longevity.”

Interestingly, higher muscle mass in men was also found to be linked to estradiol, a type of estrogen, which is mainly a female sex hormone. In addition, higher fat mass in the muscles in men seemed to be linked to the protein that transports sex hormones in the blood.

Low testosterone levels also go hand in hand with increased inflammatory levels, regardless of age and body size. This is not about a temporary infection but low-grade inflammation that affects the body over time.

“Taking care of your overall health to keep inflammation down can be just as important for hormone levels as exploring other ways to increase your testosterone levels,” says Amar Osmancevic.

Fatigue is due to other things

However, research shows that depression and fatigue in the male population lack a clear connection to testosterone deficiency. In that situation, other factors matter.

“You shouldn't focus too narrowly on nonspecific symptoms or a test result. Symptoms such as fatigue or depression seem to be due to other things than low testosterone levels, such as age, lifestyle, comorbidities and the amount of abdominal fat. Abdominal fat and age seem to be stronger drivers on future symptoms than the individual's baseline testosterone level,” concludes Amar Osmancevic.